基于理筋手法的早期功能锻炼对高龄AO-C型桡骨远端骨折患者的影响

Benefits of early functional exercise based on tendon manipulation in elderly patients with AO type-C distal radius fracture

目的:观察基于理筋手法的早期功能锻炼对高龄AO-C型桡骨远端骨折患者的影响。方法:选取2017年1月~2019年1月于我院接受治疗的80例高龄AO-C型桡骨远端骨折患者为受试对象,随机数字表法分为观察组与对照组40例。两组均给予常规治疗,对照组在其基础上给予常规中药熏洗治疗,观察组在对照组基础上联合基于理筋手法的早期功能锻炼进行治疗。比较两组治疗前、治疗3个月后的Gartland-Werley腕关节评分,并通过Stewart等改良的Sarmiento评分标准评估其治疗短期(3个月内)腕关节恢复情况,并记录其治疗前、治疗6个月后的腕关节活动度(尺偏角、掌倾角、桡骨茎突高度)、患侧握力改善程度及生活质量[生活质量综合评定(GQOLI-74)]变化。结果:治疗3个月后,两组患者Gartland-Werley腕关节评分(残余畸形、主观、客观、并发症)中各项评分及总分较治疗前均显著下降(均P<0.05),且观察组主观、客观评分及总分明显低于对照组(P<0.05);治疗3个月,两组Sarmiento评分标准分级比较差异具有统计学意义(P<0.05),且观察组优良率为90.00%,显著高于对照组的72.50%(P<0.05);治疗6个月后,两组患者尺偏角、掌倾角、桡骨茎突高度较治疗前均显著上升(P均<0.05),且观察组明显高于对照组(P<0.05);治疗6个月后,两组患者患侧握力较治疗前均显著上升(P均<0.05),且观察组明显高于对照组(P<0.05);治疗6个月后,两组患者GQOLI-74量表(躯体功能、心理功能、社会功能、物质生活状态)各维度评分均较治疗前显著上升(P均<0.05),且观察组明显高于对照组(P<0.05)。结论:在常规中药熏洗的基础上联合基于理筋手法的早期功能锻炼确可有效改善高龄AO-C型桡骨远端骨折患者临床症状,提高其腕(腕)关节功能,从而有利于生活质量的改善。

Objective:To investigate the benefits of early functional exercises based on tendon manipulation in elderly patients with AO type-C distal radius fracture.Methods:Included in this study were 80 elderly patients with AO type-C distal radius fracture treated in our hospital between January 2017 and January 2019.The subjects were divided into the study group and control group(n=40 each)by random number table.Both groups received conventional treatment.Moreover,the control group was given heat fumigating and washing with herbal Chinese medicine,while the study group underwent early functional exercises based on tendon manipulation,in addition to the care given in the control group.At baseline and at three months after treatment,the two groups were compared for Gartland-Werley scores,as well as the 3-month short-term recovery of wrist joint functions as evaluated by Stewart’s modification of Sarmiento criteria.The wrist joint mobility(ulnar deviation,volar tilt,radial height),grip strength and quality of life[as assessed via 74-item General Quality of Life Inventory(GQOLI-74)]were determined at baseline and at 6 months after treatment.Results:After 3 months of treatment,the sub-scores(residual deformity,subjectivity,objectivity and complications)and the total scores of Gartland-Werley scale in the two groups were significantly lower than those at baseline(P<0.05);the study group showed significantly lower total scores and sub-scores in subjectivity and objectivity,compared with the control group(P<0.05).At 3 months after treatment,there was a significant difference in joint functions by Sarmiento criteria between the two groups(P<0.05).The rate of excellent outcome in the study group was 90%,which was significantly higher than that in the control group(72.50%,P<0.05).At 6 months after treatment,the two groups showed significant increases in ulnar deviation,volar tilt and radial height from baseline(all P<0.05),and these values were significantly greater in the study group than those in the control group(P<0.05).At 6 months after treatment,the grip strength on the affected side increased significantly from baseline in the both groups(P<0.05),and was significantly greater in the study group than that in the control group(P<0.05).At 6 months after treatment,the GQOLI-74 scores in domains of physical function,psychological function,social function and material living in the two groups were significantly higher than baseline(P<0.05),and were significantly higher in the study group than those in the control group(P<0.05).Conclusion:Early functional exercises based on tendon manipulation,added on heat fumigation and washing with herbal Chinese medicines,may effectively improve the clinical symptoms and wrist joint function,and thereby improve the quality of life in elderly patients with AO type-C distal radius fracture.